Search

Objective Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test (OGTT) in pediatric patients with cystic fibrosis (CF) starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study was to assess and improve the screening rates at our large pediatric center. Methods A 4-year retrospective audit of OGTT completion among pediatric patients with CF of age ≥10 years who are not yet diagnosed with diabetes was conducted. A collaborative working group was formed to identify the barriers to screening and formulate a quality improvement plan, which was monitored and evaluated for a 9-month period. Results Diabetes screening rates determined by OGTT completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in OGTT ordering compliance by providers as well as test completion by patients. Notably, the fractional OGTT completion rate rose from 45% during the preintervention phase (January-April 2023) to 70% during the postintervention phase (May-September 2023). Conclusion Diabetes screening in pediatric patients with CF can be effectively improved by refining practices related to patient experience, care coordination, and laboratory testing strategies. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes is associated with adverse outcomes such as preterm birth (<37 weeks). However, there is no international consensus on screening criteria or diagnostic levels for gestational diabetes, and it is unknown whether body mass index (BMI) or obesity modifies the relation between glucose level and preterm birth. Methods: We studied a pregnancy cohort restricted to two Danish regions from the linked Danish Medical Birth Register to study associations between glucose measurements from the 2-hour postload 75-g oral glucose tolerance test (one-step approach) and preterm birth from 2004 to 2018. In Denmark, gestational diabetes screening is a targeted strategy for mothers with identified risk factors. We used Poisson regression to estimate rate ratios (RR) of preterm birth with z-standardized glucose measurements. We assessed effect measure modification by stratifying analyses and testing for heterogeneity. Results: Among 11,337 pregnancies (6.2% delivered preterm), we observed an adjusted preterm birth RR of 1.2 (95% confidence interval [CI] = 1.1, 1.3) for a one-standard deviation glucose increase of 1.4 mmol/l from the mean of 6.7 mmol/l. There was evidence for effect measure modification by obesity, for example, adjusted RR for nonobese (BMI, <30): 1.2 (95% CI = 1.1, 1.3) versus obese (BMI, ≥30): 1.3 (95% CI = 1.2-1.5), P = 0.05 for heterogeneity. Conclusion: Among mothers screened for gestational diabetes, increased glucose levels, even those below the diagnostic level for gestational diabetes in Denmark, were associated with increased preterm birth risk. Obesity (BMI, ≥30) may be an effect measure modifier, not just a confounder, of the relation between blood glucose and preterm birth risk. [ABSTRACT FROM AUTHOR]

Despite clinical guidelines do not recommend the use of point-of-care testing (POCT) glucometers for diagnostic purposes yet, the analytical performance is continuously improving. Thus, we evaluate the technical accuracy and clinical concordance of POCT glucometers during an oral glucose tolerance test (OGTT) in children for prediabetes and diabetes diagnosis in a comparison study. Pediatric patients with an OGTT indication who attended the Diabetes Unit between December 2020 and September 2021 were recruited for this prospective observational study. During the functional test, glycaemia was immediately measured in venous blood using two glucometers (unconnected and connected) and sent to the central laboratory. The study included 98 patients. There was a high correlation between the glucometers and the central laboratory (Pearson correlation coefficient=0.912 and 0.950, for unconnected and connected glucometer, respectively). The median OGTT turnaround time (TAT) was significantly decreased (connected glucometer: 2.02 h [interquartile range, 2.00–2.07], central laboratory: 11.63 h [6.09–25.80]), with similar overall cost. The diagnostic concordance between connected glucometer and the central laboratory was 71.1 % (95 % confidence interval (CI) 61.5–79.2). The clinical decision would have been the same in the 92.8 % of the cases, but treatment would have not been indicated in 4 patients (4.1 %). POCT glucometers have demonstrated a high correlation and an acceptable diagnostic concordance with the central laboratory during an OGTT, as well the connected device offers a significant decrease in TAT, without increasing costs. However, as severe clinical impact could happen, POCT glucometers may not be used for diagnosis yet. [ABSTRACT FROM AUTHOR]

Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women's diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one's previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2–3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann–Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2–3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values. [ABSTRACT FROM AUTHOR]

Background: Previous studies showed that residents of higher elevations have lower glucose levels. Our objective in this study is to determine the basal and postprandial glucose levels in apparently healthy permanent residents of the miner population center of La Rinconada located 5100 meters (m) above sea level. Method: Forty male permanent residents of the Rinconada miner population center were studied. The oral glucose tolerance test was used to evaluate basal and postprandial glycemia levels at 1, 2, and 3 h. Results: The individuals had a mean age of 43.95 ± 8.54 years. Basal glycemia in subjects without excessive erythrocytosis (EE) was 73.3 ± 7.9 mg/dL, while levels in patients with EE were 57.98 ± 7.38 mg/dL. In the postprandial period, at 1 h after oral glucose overload, a mean value of 76.35 ± 13.53 mg/dL was observed in subjects with EE compared to 94.68 ± 9.98 mg/dL in subjects without EE. After 2 h, subjects with EE had a glycemia level of 72.91 ± 9.17 mg/dL EE compared to 90.73 ± 13.86 mg/dL without EE. At 3 h, the average glycemia level in subjects with EE was 70.77 ± 8.73 mg/dL compared to 87.79 ± 14.16 mg/dL in those without EE. Conclusion: These findings suggest that under hypoxic conditions, glycemia levels are lower in both subjects with and without EE, having obtained lower levels in subjects with EE in relation to those with normal values of Hb and Hct. The results of this study indicate that in the conditions of severe hypoxia, blood glucose levels are below the values considered normal for sea level. [ABSTRACT FROM AUTHOR]

Background: There is currently a scarcity of population-based records related to the prevalence of gestational diabetes mellitus (GDM) in India. There were various recommendations for screening and diagnostic tests for GDM, and no uniform standard has yet been established. Hence, a comparative study was conducted to assess the usefulness of the glucose challenge test (GCT) and fasting blood glucose (FBG)/post-prandial blood glucose (PPBG) test for the screening of GDM in pregnant women attending the prenatal clinic outpatient department. Methods: This is a comparative observational study involving 300 apparently normal pregnant who were randomly allocated to GCT and FBG/PPBG cohorts of 150 each. The tests were performed at 4 intervals: 8 to 10 weeks, 16 to 20 weeks, 24 to 28 weeks, and 32 to 36 weeks. All diagnosed GDM cases were appropriately handled. Results: Gestational diabetes mellitus was seen in 2.67% of the FBG/PPBG cohort and 5.34% of the GCT cohort. The GCT test identified 25% of GDM subjects before 24 weeks of gestation, 50% in 24 and 28 weeks, and 25% in > 32 weeks of gestation. The highest prevalence of GDM was noted in the 26–30-year age group. The highest prevalence of GDM was noted in pregnant women with ≥ 26 kg/m2 of body mass index (BMI), with 75% in the FBG/PPBG group and 62.5% in the GCT group. The incidence of GDM was higher in primigravida, 75% in the FBG/PPBG group, and 50% in the GCT group. A higher prevalence was observed in pregnant women of class 4 of socioeconomic status, and it was 75% in the FBG/PPBG group and 75% in the GCT group. A higher prevalence was noted in those with higher secondary education. The majority of GDM cases gave birth at term by labor, and there were no assisted vaginal births in this group. Moreover, 75% of GDM cases in the FBG/PPBG cohort and 62.5% of GDM cases in the GCT cohort had Caesarean section. Besides, 50% of infants from GDM mothers in the FBG/PPBG cohort were hospitalized, while 12.75% were admitted in the GCT cohort. The birth weight of neonates from GDM mothers was 3.09 ± 0.5 kg, 3.11 ± 0.6 kg in normal mothers, 2.98 ± 0.6 kg in the FBG/PPBG cohort, and 2.9 ± 0.5 kg in the GCT cohort. Conclusion: Irrespective of the last meal, the GCT in all pregnant women is an effective and easy screening approach for 1-step screening for the early diagnosis of GDM for subsequent management at the early gestational pregnancy, which can minimize the adverse obstetric and perinatal outcomes.

Abstract Background Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India. Methods We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India. Results Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0–13.0%, I2 =96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0–16.0%, I2 = 99%]. Conclusions This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country.

Abstract Background A variety of screening tools and criteria are used for the diagnosis of gestational diabetes mellitus (GDM). As a result, the prevalence rate of GDM varied from 4.41% to 57.90% among studies from Pakistan. Beside this disagreement, similar multi-centric studies, community surveys and pooled evidence were lacking from the country. Therefore, this first systematic review and meta-analysis aimed to measure the overall and subgroup pooled estimates of GDM and explore the methodological variations among studies for any inconsistency. Methods Using the PRISMA guidelines, seventy studies were identified from PubMed, ScienceDirect, Google Scholar and PakMediNet database. Of them, twenty-four relevant studies were considered for systematic review and nine eligible studies selected for meta-analysis. AXIS was used for measuring quality of reporting, I^2 statistics for heterogeneity among studies and subgroups, funnel plot for reporting potential publication bias and forest plot for presenting pooled estimates. Results The pooled sample of nine studies was 27,034 (126 – 12,450) pregnant women, of any gestational age, from all four provinces of Pakistan. Overall pooled estimate of GDM was 16.7% (95% CI 13.1 – 21.1). The highest subgroup pooled estimate of GDM observed in studies from Balochistan (35.8%), followed by Islamabad (23.9%), Khyber Pakhtunkhwa (17.2%), Sindh (13.2%), and Punjab (11.4%). The studies that adopted 75g 2-h OGTT had a little lower pooled estimate (16.3% vs. 17.3%); and that adopted diagnostic cut-off values [≥ 92 (F), ≥ 180 (1-h) and ≥ 153 (2-h)] had a greater pooled estimate (25.4% vs. 15.8%). The studies that adopted Carpenter criteria demonstrated the highest subgroup pooled estimate of GDM (26.3%), after that IADPSG criteria (25.4%), and ADA criteria (23.9%). Conclusions Along with poor quality of reporting, publishing in non-indexed journals and significant disagreement between studies, the prevalence rate of GDM is high in Pakistan. Consensus building among stakeholders for recommended screening methods; and continuous medical education of the physicians are much needed for a timely detection and treatment of GDM.

This study aimed to investigate the use of leptin as a marker for gestational diabetes by analyzing any correlation between serum leptin levels versus oral glucose tolerance tests (at 24 to 28 weeks of pregnancy) and increased body weight (during pregnancy). A total of 110 female cases (81 pregnant and 29 non-pregnant) were included in the study. The 81 pregnant cases were divided into 3 groups according to their oral glucose tolerance test results. A chi-square test was used for categorical variables. The distribution of numerical variables was tested with the Shapiro–Wilk test. ANOVA and a post-hoc Bonferroni test was used for parametric data. Kruskal–Wallis variance analysis was used for non-parametric data. The Mann–Whitney U-test was used for pairwise comparisons. Spearman correlation analysis and multivariate regression analysis were performed for the evaluation of the correlation analysis between the parameters. Oral glucose tolerance test results were compared with leptin levels with a cut-off value of 11.43 for leptin. The ROC curve demonstrated an 83.3% sensitivity and 72.1% specificity for leptin. Leptin may play a role in the pathophysiology of gestational diabetes mellitus. However, the relationship between leptin levels and maternal weight gain during pregnancy is still unknown. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India. Methods: We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India. Results: Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0–13.0%, I2=96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0–16.0%, I2 = 99%]. Conclusions: This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country. [ABSTRACT FROM AUTHOR]

Background: A variety of screening tools and criteria are used for the diagnosis of gestational diabetes mellitus (GDM). As a result, the prevalence rate of GDM varied from 4.41% to 57.90% among studies from Pakistan. Beside this disagreement, similar multi-centric studies, community surveys and pooled evidence were lacking from the country. Therefore, this first systematic review and meta-analysis aimed to measure the overall and subgroup pooled estimates of GDM and explore the methodological variations among studies for any inconsistency. Methods: Using the PRISMA guidelines, seventy studies were identified from PubMed, ScienceDirect, Google Scholar and PakMediNet database. Of them, twenty-four relevant studies were considered for systematic review and nine eligible studies selected for meta-analysis. AXIS was used for measuring quality of reporting, I^2 statistics for heterogeneity among studies and subgroups, funnel plot for reporting potential publication bias and forest plot for presenting pooled estimates. Results: The pooled sample of nine studies was 27,034 (126 – 12,450) pregnant women, of any gestational age, from all four provinces of Pakistan. Overall pooled estimate of GDM was 16.7% (95% CI 13.1 – 21.1). The highest subgroup pooled estimate of GDM observed in studies from Balochistan (35.8%), followed by Islamabad (23.9%), Khyber Pakhtunkhwa (17.2%), Sindh (13.2%), and Punjab (11.4%). The studies that adopted 75g 2-h OGTT had a little lower pooled estimate (16.3% vs. 17.3%); and that adopted diagnostic cut-off values [≥ 92 (F), ≥ 180 (1-h) and ≥ 153 (2-h)] had a greater pooled estimate (25.4% vs. 15.8%). The studies that adopted Carpenter criteria demonstrated the highest subgroup pooled estimate of GDM (26.3%), after that IADPSG criteria (25.4%), and ADA criteria (23.9%). Conclusions: Along with poor quality of reporting, publishing in non-indexed journals and significant disagreement between studies, the prevalence rate of GDM is high in Pakistan. Consensus building among stakeholders for recommended screening methods; and continuous medical education of the physicians are much needed for a timely detection and treatment of GDM. [ABSTRACT FROM AUTHOR]

Objective: To establish diagnostic criteria for the 75‐g 2‐h glucose tolerance test (GTT) to diagnose gestational diabetes and define the clinical entity of gestational hyperglycemia. Methods: A retrospective analysis was performed of the results from 500 patients who had a 75‐g 1‐h glucose challenge test (GCT) in early pregnancy as part of a two‐step approach to screening and testing for gestational diabetes. The selected cohort was considered to have normal islet β‐cell function, and upper glycemic levels of normal glucose tolerance in the third trimester were statistically calculated, taking the cutoff threshold values to be the diagnostic criteria for the 75‐g 2‐h GTT. Gestational hyperglycemia was diagnosed from the false‐positive GCT result when ≥8.0 mmol/L (144 mg/dL). Results: The diagnostic criteria for the 75‐g 2‐h GTT were calculated as follows: fasting plasma glucose ≥5.4 mmol/L (97 mg/dL); 1‐h plasma glucose ≥10.5 mmol/L (189 mg/dL); and 2‐h plasma glucose ≥8.4 mmol/L (151 mg/dL). The new criteria confirmed a prevalence of gestational diabetes of 11.1% and gestational hyperglycemia of 13.6% in the study population. Conclusion: Novel diagnostic criteria for the 75‐g 2‐h GTT were established by statistical analysis. This resulted in a more acceptable prevalence of gestational diabetes in our community and the false‐positive GCT allowed the detection of gestational hyperglycemia. Synopsis: Novel diagnostic criteria for the glucose tolerance test to diagnose gestational diabetes and gestational hyperglycemia have been established by statistical analysis. [ABSTRACT FROM AUTHOR]

Background: There is currently a scarcity of population-based records related to the prevalence of gestational diabetes mellitus (GDM) in India. There were various recommendations for screening and diagnostic tests for GDM, and no uniform standard has yet been established. Hence, a comparative study was conducted to assess the usefulness of the glucose challenge test (GCT) and fasting blood glucose (FBG)/post-prandial blood glucose (PPBG) test for the screening of GDM in pregnant women attending the prenatal clinic outpatient department. Methods: This is a comparative observational study involving 300 apparently normal pregnant who were randomly allocated to GCT and FBG/PPBG cohorts of 150 each. The tests were performed at 4 intervals: 8 to 10 weeks, 16 to 20 weeks, 24 to 28 weeks, and 32 to 36 weeks. All diagnosed GDM cases were appropriately handled. Results: Gestational diabetes mellitus was seen in 2.67% of the FBG/PPBG cohort and 5.34% of the GCT cohort. The GCT test identified 25% of GDM subjects before 24 weeks of gestation, 50% in 24 and 28 weeks, and 25% in > 32 weeks of gestation. The highest prevalence of GDM was noted in the 26–30-year age group. The highest prevalence of GDM was noted in pregnant women with ≥ 26 kg/m2 of body mass index (BMI), with 75% in the FBG/PPBG group and 62.5% in the GCT group. The incidence of GDM was higher in primigravida, 75% in the FBG/PPBG group, and 50% in the GCT group. A higher prevalence was observed in pregnant women of class 4 of socioeconomic status, and it was 75% in the FBG/PPBG group and 75% in the GCT group. A higher prevalence was noted in those with higher secondary education. The majority of GDM cases gave birth at term by labor, and there were no assisted vaginal births in this group. Moreover, 75% of GDM cases in the FBG/PPBG cohort and 62.5% of GDM cases in the GCT cohort had Caesarean section. Besides, 50% of infants from GDM mothers in the FBG/PPBG cohort were hospitalized, while 12.75% were admitted in the GCT cohort. The birth weight of neonates from GDM mothers was 3.09 ± 0.5 kg, 3.11 ± 0.6 kg in normal mothers, 2.98 ± 0.6 kg in the FBG/PPBG cohort, and 2.9 ± 0.5 kg in the GCT cohort. Conclusion: Irrespective of the last meal, the GCT in all pregnant women is an effective and easy screening approach for 1-step screening for the early diagnosis of GDM for subsequent management at the early gestational pregnancy, which can minimize the adverse obstetric and perinatal outcomes. [ABSTRACT FROM AUTHOR]

In this paper, we delve into the realm of mathematical modeling as a powerful theoretical tool to understand essential aspects of medical-biological phenomena. This study focuses on developing a mathematical model incorporating the incomplete I-function (IIF) and estimating glucose supply in the human bloodstream. The results of our investigations are far-reaching, revealing many exciting scenarios across the various parameters under investigation. These results are not only practical but can also play an essential role in the contexts of medical and biological fields.

BackgroundPrevious studies showed that residents of higher elevations have lower glucose levels. Our objective in this study is to determine the basal and postprandial glucose levels in apparently healthy permanent residents of the miner population center of La Rinconada located 5100 meters (m) above sea level.MethodForty male permanent residents of the Rinconada miner population center were studied. The oral glucose tolerance test was used to evaluate basal and postprandial glycemia levels at 1, 2, and 3 h.ResultsThe individuals had a mean age of 43.95 ± 8.54 years. Basal glycemia in subjects without excessive erythrocytosis (EE) was 73.3 ± 7.9 mg/dL, while levels in patients with EE were 57.98 ± 7.38 mg/dL. In the postprandial period, at 1 h after oral glucose overload, a mean value of 76.35 ± 13.53 mg/dL was observed in subjects with EE compared to 94.68 ± 9.98 mg/dL in subjects without EE. After 2 h, subjects with EE had a glycemia level of 72.91 ± 9.17 mg/dL EE compared to 90.73 ± 13.86 mg/dL without EE. At 3 h, the average glycemia level in subjects with EE was 70.77 ± 8.73 mg/dL compared to 87.79 ± 14.16 mg/dL in those without EE.ConclusionThese findings suggest that under hypoxic conditions, glycemia levels are lower in both subjects with and without EE, having obtained lower levels in subjects with EE in relation to those with normal values of Hb and Hct. The results of this study indicate that in the conditions of severe hypoxia, blood glucose levels are below the values considered normal for sea level.

Despite clinical guidelines do not recommend the use of point-of-care testing (POCT) glucometers for diagnostic purposes yet, the analytical performance is continuously improving. Thus, we evaluate the technical accuracy and clinical concordance of POCT glucometers during an oral glucose tolerance test (OGTT) in children for prediabetes and diabetes diagnosis in a comparison study.

Objective The aim of the study is to evaluate whether values and the shape of the glucose curve during the oral glucose tolerance test (OGTT) in pregnancy identify women at risk of developing hypertension (HTN) later in life. Study Design This category includes the secondary analysis of a follow-up from a mild gestational diabetes mellitus (GDM) study that included a treatment trial for mild GDM (n = 458) and an observational cohort of participants with abnormal 1-hour glucose loading test only (normal OGTT, n = 430). Participants were assessed at a median of 7 (IQR 6–8) years after their index pregnancy, and trained staff measured their blood pressure (systolic blood pressure [SBP]; diastolic blood pressure [DBP]). The association between values and the shape of the glucose curve during OGTT in the index pregnancy and the primary outcome defined as elevated BP (SBP ≥120, DBP ≥80 mm Hg, or receiving anti-HTN medications), and secondary outcome defined as stage 1 or higher (SBP ≥130, DBP ≥80 mm Hg, or receiving anti-HTN medications) at follow-up were evaluated using multivariable regression, adjusting for maternal age, body mass index, and pregnancy-associated hypertension during the index pregnancy. Results There was no association between fasting, 1-hour OGTT, and the outcomes. However, the 2-hour OGTT value was positively associated (adjusted odds ratio [aRR] per 10-unit increase 1.04, 95% CI 1.01–1.08), and the 3-hour was inversely associated (aRR per 10-unit increase 0.96, 95% CI 0.93–0.99) with the primary outcome. When the shape of the OGTT curve was evaluated, a monophasic OGTT response (peak at 1 hour followed by a decline in glucose) was associated with increased risk of elevated BP (41.3vs. 23.5%, aRR 1.66, 95% CI 1.17–2.35) and stage 1 HTN or higher (28.5 vs. 14.7%, aRR 1.83, 95% CI 1.15–2.92), compared with a biphasic OGTT response. Conclusion Among persons with mild GDM or lesser degrees of glucose intolerance, the shape of the OGTT curve during pregnancy may help identify women who are at risk of HTN later in life, with biphasic shape to be associated with lower risk. Key Points The shape of the Oral Glucose Tolerance Test curve may help identify patients who are at risk of having elevated BP or HTN 5 to 10 years following pregnancy. The 2-hour Oral Glucose Tolerance Test values is positively associated with elevated BP 5 to 10 years following pregnancy. This supports the concept of pregnancy as a window to future health and represents a potential novel biomarker for maternal cardiovascular health screening. [ABSTRACT FROM AUTHOR]

Carbohydrates are a common and economical energy source in animal feeds. However, most fish show a persistent postprandial hyperglycemia after intake of a high-carbohydrate diet. Unfortunately, the mechanism of glucose metabolism in fish is still unclear. In the present study, tiger puffer (Takifugu rubripes) and turbot (Scophthalmus maximus) were intraperitoneally injected or orally administered with glucose or fructose (500 mg/kg body weight) to evaluate the ability of fish to utilize carbohydrates. Afterwards, serum glucose, fructose, pyruvate, insulin levels, and acute hypoxia tolerance were measured. Our results showed increased serum glucose level and then decreased post intraperitoneal injection with glucose, and reached a peak after 0.5 hours in turbot and 1 hour in tiger puffer. Tiger puffer had significantly lower liver glycogen, serum glucose, fructose, pyruvate, and insulin contents than turbot. Glucose and fructose only induced insulin secretion in turbot, but did not change serum insulin level in tiger puffer. Glucose was a stronger stimulator of insulin than fructose in the two marine species. Both intraperitoneal injection and oral fructose intake increased serum glucose level, while intraperitoneal or oral glucose also increased serum fructose level. Intraperitoneal injection of glucose promoted absorption and utilization of glucose in the blood more effectively than oral glucose intake. In addition, turbot and tiger puffer were intolerant to acute hypoxia, whereas supplementation with glucose or fructose improved hypoxia tolerance in the two marine fishes by activating anaerobic glycolysis. Taken together, our results provide important scientific information for understanding the mechanism for glucose and fructose utilization and improving hypoxia tolerance in fish. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluated if fetuses of subjects with one elevated value on the 3-h GTT had a measurable physiologic difference in fetal C-peptide levels as compared to those with no elevated values on the GTT. Methods: We performed a prospective cohort study to evaluate insulin levels in singleton non-anomalous fetuses of subjects with one elevated value on the GTT as compared to subjects with no elevated values on their GTT. Fetal insulin levels were measured by fetal C-peptide in cord blood. Distribution of data was assessed and outliers representing values > the 99th and < the 1st percentiles were excluded. Data were log transformed to achieve normal distribution and univariable analyses were performed to compare fetal C-peptide levels, baseline maternal characteristics and perinatal outcomes in subjects with one elevated value as compared those with no elevated values. Results: Our analysis included 99 subjects, with 49 subjects in the one elevated value group and 50 subjects in the no elevated values group. Fetal C-peptide levels (picomoles per liters, pmol/L), were significantly higher in the elevated value group as compared to the no elevated value group (mean ± SD; 4.6 ± 0.8 vs. 4.3 ± 0.7, P = 0.046, respectively). In univariable analysis, there was no significant difference in maternal characteristics or adverse composite perinatal outcomes. Conclusion: Fetuses of subjects who had one elevated value on their GTT had a measurable physiologic difference in C-peptide levels as compared to fetuses of subjects with no elevated values on the GTT. [ABSTRACT FROM AUTHOR]

The aim of the work was to define the pattern of changes and pathogenetic mechanisms of glycemic curve shape during a glucose tolerance test in rats at 6, 15, and 21 weeks of environmental space restriction. Materials and methods. A total of 55 male Wistar rats aged 6–10 months were used and divided into 4 groups (1 – intact control, 10 rats; 2, 3 and 4 of 15 rats each, which were in conditions of restricted environmental space for 6, 15 and 21 weeks, respectively). Fasting plasma levels of glucose (test strips Test Strip II on a Glucocard glucometer (ARKRAY Inc., Japan)), insulin and corticosterone (by an immunoenzymatic method using commercial kits for rats from Monobind, USA) were measured, glucose tolerance tests (GTT) were performed, the HOMA index and the insulin/corticosterone ratio were calculated. Results. The 6-week environmental space restriction, immobility and complex communication relations resulted in a hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity in animals which were in the conditions described (the HOMA index was significantly decreased to 0.21 versus 0.55 in the control), the characteristic delayed hyperglycemic peak at the 30th min of the test slowly returned to the euglycemic level by only the 90th min against the 30th min in the controls. The 15-week restriction caused a hypoinsulinemic curve with preserved tissue glucose sensitivity (the HOMA index 0.33 versus 0.55 in the controls). Alterations in postprandial glucose absorption were manifested by the highest glucose concentration at the 15th min of the test, a very slow decrease in the glucose level in the post-absorption period not being restored to baseline values by the 90th min. The 21-week restriction shaped a diabetic type of the glycemic curve, impaired tissue glucose sensitivity (a substantial and significant increase in the calculated HOMA index from 0.55 in the controls to 0.95) and resulted in the development of insulin resistance. Conclusions. The environmental space restriction, immobility and complex communication relations gradually induce a range of disorders in animals and change the glycemic response shape to glucose load, impair prandial insulin secretion, augment hyperglycemic effects of counterinsular hormones (corticosterone), and realize dysfunctional manifestations of prandial/postprandial glycemia. 6 weeks of restrictions and challenges shape the hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity, while 15 weeks result in the hypoinsulinemic curve with preserved tissue glucose sensitivity. 21 weeks show the diabetic type of the glycemic curve with impaired tissue glucose sensitivity and the development of insulin resistance.

Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women’s diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one’s previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2–3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann–Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2–3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values.

Objective: This study was performed to determine the effect of fasting on reproducibility of the glucose tolerance test. Due to individual variation in animal feeding behaviors, fasting animals prior to metabolic and behavioral experiments is widely held to reduce inter-subject variation in glucose and metabolic parameters of preclinical rodent models. Reducing variability is especially important for studies where initial metabolite levels can influence the magnitude of experimental interventions, but fasting also imposes stress that may distort the variables of interest. One such intervention is the glucose tolerance test (GTT) which measures the maximum response and recovery following a bolus of exogenous glucose. We sought to investigate how fasting affects the response of individual mice to a GTT. Methods: Using simultaneous continuous glucose monitoring (CGM) and indirect calorimetry, we quantified blood glucose, physical activity, body temperature, metabolic rates, and food consumption levels on a minute-to-minute basis in adult male mice for 4 weeks. We tested the effects of a 4-h or 18-h fast on the GTT to examine the effect of food withdrawal in light or dark photoperiods. Studies were also performed with 4-h fasting in additional mice without implanted CGM probes. Results: Contrary to our expectations, a 4-h fast during the light photoperiod promotes a paradoxical increase in inter-animal variation in metabolic rate, physical activity, body temperature, glycemia, and glucose tolerance. This hyperglycemic and hyper-metabolic phenotype promotes increased corticosterone levels and is consistent with a behavioral stress response to food deprivation, even in well-fed mice. We find that mice undergoing an 18-h fast entered torpor, a hibernation-like state. In addition to low body temperature and metabolic rate, torpor is also associated with glucose levels 56 mg/dl lower than those seen in mice with ad libitum access to food. Moreover, the time spent in torpor affects the response to a GTT. Conclusion: Our results suggest fasting mice before glucose tolerance testing, and perhaps other experiments, can have the opposite of the intended effect where fasting can increase, rather than decrease, experimental variability.

Background: Diabetes mellitus is a common and crucial metabolic complication in kidney transplantation. It is necessary to analyze the course of glucose metabolism in patients who already have diabetes after receiving a transplant. In this study, we investigated the changes in glucose metabolism after transplantation, and a detailed analysis was performed on some patients whose glycemic status improved. Methods: The multicenter prospective cohort study was conducted between 1 April 2016 and 31 September 2018. Adult patients (aged 20 to 65 years) who received kidney allografts from living or deceased donors were included. Seventy-four subjects with pre-transplant diabetes were followed up for 1 year after kidney transplantation. Diabetes remission was defined as the results of the oral glucose tolerance test performed one year after transplantation and the presence or absence of diabetes medications. After 1-year post-transplant, 74 recipients were divided into the persistent diabetes group (n = 58) and the remission group (n = 16). Multivariable logistic regression was performed to identify clinical factors associated with diabetes remission. Results: Of 74 recipients, 16 (21.6%) showed diabetes remission after 1-year post-transplant. The homeostatic model assessment for insulin resistance numerically increased in both groups throughout the first year after transplantation and significantly increased in the persistent diabetes group. The insulinogenic index (IGI30) value significantly increased only in the remission group, and the IGI30 value remained low in the persistent diabetes group. In univariate analysis, younger age, newly diagnosed diabetes before transplantation, low baseline hemoglobin A1c, and high baseline IGI30 were significantly associated with remission of diabetes. After multivariate analysis, only newly diagnosed diabetes before transplantation and IGI30 at baseline were associated with remission of diabetes (34.00 [1.192-969.84], P = 0.039, and 17.625 [1.412-220.001], P = 0.026, respectively). Conclusion: In conclusion, some kidney recipients with pre-transplant diabetes have diabetes remission 1 year after transplantation. Our prospective study revealed that preserved insulin secretory function and newly diagnosed diabetes at the time of kidney transplantation were favorable factors for which glucose metabolism did not worsen or improve 1 year after kidney transplantation. [ABSTRACT FROM AUTHOR]

Background and Objectives There exists a limited body of research investigating the correlation between gestational diabetes mellitus (GDM) with fetal epicardial fat thickness (FEFT). The primary objective of this study was to assess the potential of FEFT as an indicator for screening GDM in pregnant women. The study was designed as a cross-sectional analytical investigation. Materials & methods The study incorporated pregnant women who were scheduled to undergo a 75g oral glucose tolerance test (OGTT). Antenatal ultrasonography (USG) were conducted in all patients. Among the total of 200 patients, a subset of 70 patients was selected for further analysis. This subset included 35 patients with elevated results in the 75g OGTT (indicating cases of GDM) and 35 patients with normal results. Results: There was a significant increase in FEFT among pregnant women with GDM. Furthermore, the elevated FEFT demonstrated a positive correlation with 2-hour OGTT serum glucose values. The mean FEFT in mothers with GDM was found to be significantly larger compared to mothers without GDM. To assess the predictive capability of FEFT for GDM, an ROC curve was constructed which demonstrated a high sensitivity of 95.57% and specificity of 91% for FEFT as a predictor of GDM. Conclusion: Assessing the FEFT in fetuses could serve as a novel marker for diagnosing GDM. [ABSTRACT FROM AUTHOR]

The proportion of adipose depots varies considerably between fattailed (FT) and thin-tailed (TT) sheep breeds. FT breeds accumulate majority of body fat in fat-tail depot, whereas TT breeds deposit considerable proportion of body fat in visceral depots. These differences in proportion of adipose depots seem to affect body metabolism due to differences in metabolism of different depots. Hence, the current research aimed to evaluate the response of fat-tailed lambs (FTL) and thin-tailed lambs (TTL) to glucose and insulin challenges during negative energy balance (NEB) and positive energy balance (PEB). Glucose tolerance and insulin challenge tests were conducted on randomly selected lambs from each genotypes at the end of induced NEB and PEB. Glucose injection during NEB caused greater plasma glucose concentration in TTL, whereas in PEB, the enhancement in glucose concentration as a consequence of glucose injection was higher in FTL (P=0.09). The area under the glucose curve was higher in FT compared to TT lambs during glucose tolerance test regardless of energy balance (EB; P=0.03). The clearance rates of insulin (P=0.09) and glucose (P=0.006) in the respective insulin and glucose tolerance tests were higher during PEB compared to NEB regardless of the genotypes. These results demonstrated that induced NEB can enhance insulin resistance in both FT and TT lambs, severity of which is greater in FT than in TT lambs. [ABSTRACT FROM AUTHOR]

As many as 1 in 3 patients with gestational diabetes mellitus have impaired glucose metabolism when screened postpartum. These patients have a 40% to 70% lifetime risk of progression to type 2 diabetes mellitus, but progression can be delayed or prevented by lifestyle interventions or medication. The American College of Obstetricians and Gynecologists and the American Diabetes Association recommend a glucose tolerance test at 4 to 12 weeks postpartum for all patients with gestational diabetes mellitus. Despite these recommendations, postpartum screening rates are typically <50%, representing a major healthcare "quality gap." The Society for Maternal-Fetal Medicine proposes a uniform metric that identifies the percentage of persons with gestational diabetes mellitus who completed a 75-g, 2-hour glucose tolerance test within 12 weeks after delivery. The metric is designed to be measured using diagnosis and procedure codes in payor claims data. Barriers to screening are discussed. Possible uses of the metric for quality improvement projects are outlined. Increasing the rate of postpartum diabetes screening should facilitate timely referral to implement lifestyle modifications, medication, and long-term follow-up. Use of the metric in financial incentive programs is discouraged at this time. [ABSTRACT FROM AUTHOR]

Background and objective: Gestational diabetes mellitus is the most common metabolic disorder of pregnancy with increasing prevalence at epidemic rates. This study aimed to determine the prevalence of gestational diabetes mellitus and related risk factors in a sample of pregnant women in Erbil city. Methods: A cross-sectional study was conducted on a convenience sample of 216 pregnant women at primary health care centers in Erbil city, Kurdistan Region, Iraq, from April 2019 to January 2021. The pregnant women were selected independent of having or not having risk factors. Pregnant women were screened for diabetes mellitus using 50 gm glucose challenge test in 24–28th weeks of gestational age. Women with positive glucose challenge test underwent 100 g glucose tolerance test. Results: The 50g glucose challenge test revealed that 54 women (25.0%) were positive for gestational diabetes mellitus. Glucose tolerance test (100 gm) revealed that the prevalence of diabetes among the sample was 11.9%. The association between the different characteristics and risk factors with the diagnosed diabetic status of the study participants showed that there was a significant association with the older age, obesity, higher parity, and history of recurrent miscarriage. Conclusion: Pregnancy is associated with a high prevalence of gestational diabetes mellitus in the current research. Pregnant women, particularly those in advanced maternal age, with pre-pregnancy high body mass index and having a history of recurrent miscarriages, should be investigated for the possibility of the presence of gestational diabetes mellitus.

Background: Gestational diabetes mellitus (GDM) is associated with hypertension, preeclampsia, stillbirth, macrosomia, unexplained intrauterine death, instrumental and traumatic delivery leading to both maternal and foetal injuries, and increased risk of maternal and neonatal infections. The present study was conducted at Rajendra Institute of Medical Sciences, Ranchi to determine the prevalence of Gestational Diabetes Mellitus(GDM) and its associated risk factors in tribal population of Jharkhand. Aims and Objectives: The aim of the study was to determine the prevalence of GDM and to analyze its association with various risk factors. Materials and Methods: Detailed history of all patients was taken with emphasis on genetic and family history and history of the previous pregnancies. All the patients were screened by the single step 75 gm 2 hours oral glucose tolerance test (OGTT) as recommended by the World Health Organization. GDM was diagnosed if 2 hours PG is ≥140 mg/dL. Results: Most patients of GDM were from upper middle class 45.45%, followed by lower middle class (27.27%) and upper lower class (18.18%). For the non-GDM patients, most patients were from upper lower class (55.055%), followed by upper middle (24.71%). The prevalence of GDM was 12.12 % in the tribal population as compared to non-tribal population (10.44 %). In present study, in majority (89.00 %) of study subjects, result of 75 gm OGTT was negative. Result of 75 gm OGTT was positive in only 11 out of 100 study subjects (11.00 %). Conclusion: Tribal population in Jharkhand has very poor access to health-care services of the state. This study is first of its kind in our state which will set as an eye opener to further deliver better health-care facilities at grassroot level in Jharkhand.

Abstract Background Pregnancy, parturition, and the onset of lactation represent an enormous physiological and hormonal challenge to the homeostasis of dairy animals, being a risk for their health and reproduction. Thus, as a part of the homothetic changes in preparturition period, goats undergo a period of IR as well as uncoupled GH/IGF-1 axis. The objective for this study was to determine the effect of berberine (BBR) during the peripartal period on hormonal alteration and somatotropic axis in dairy goats as well as glucose and insulin kinetics during an intravenous glucose tolerance test (IVGTT). At 21 days before the expected kidding date, 24 primiparous Saanen goats were assigned randomly to 4 dietary treatments. Goats were fed a basal diet from wk. 3 antepartum (AP) until wk. 3 postpartum (PP) supplemented with 0 (CTRL), 1 (BBR1), 2 (BBR2), and 4 (BBR4) g/d BBR. Blood samples were collected on days − 21, − 14, − 7, 0, 7, 14, and 21 relative to the expected kidding date. An IVGTT was also performed on day 22 PP. Results Compared with CTRL, supplementation with either BBR2 or BBR4 increased DMI at kidding day and PP, as well as body conditional score (BCS) and milk production (p ≤ 0.05). On d 7 and 14 PP plasma glucose was higher in BBR2- and BBR4-treated than in CTRL. The glucagon concentration was not affected by BBR during the experimental period. However, supplemental BBR indicated a tendency to decrease in cortisol concentration on days 7 (p = 0.093) and 14 (p = 0.100) PP. Lower plasma GH was observed in BBR than in non-BBR goats (p ≤ 0.05). Plasma IGF-1 concentration was enhanced in both BBR2 and BBR4 at kidding and day 7 PP (p ≤ 0.05). During the IVGTT, glucose area under the curve (AUC), clearance rate (CR), T1/2, and Tbasal was lower (p ≤ 0.05) in both BBR2 and BBR4 goats as compared with CTRL. Likewise, the insulin CR was higher (p ≤ 0.05) in goats receiving either BBR2 or BBR4 which was accompanied by a lower insulin T1/2 and AUC. Conclusions Altogether, our results indicated an improved glucose and insulin status along with the modulation of the somatotropic axis and glucose and insulin response to IVGTT in dairy goats supplemented with 2 and 4 g/d BBR.

Background Oral glucose loading may affect oxidative status during oral glucose tolerance test (OGTT). We aimed to investigate how oxidant and antioxidant markers and thiol/disulfide parameters change during OGTT. Methods OGTT was performed to 42 volunteers who were considered risk of type 2 diabetes and were divided into three groups (normoglycemic, prediabetes, diabetes) according glucose levels during OGTT. Glucose, insulin, c-peptide, total antioxidant status (TAS), total oxidant status (TOS), total thiol and native thiol were investigated with auto-anaylzer for five-hours period. Results Decrease of TAS and increase of TOS levels began with the increase in glucose and insulin levels. The increase of TAS started at third hour and reached the highest levels at fifth hour. OSI levels were higher at fourth hour than fasting and first hours in normoglycemic and diabetes groups. In the prediabetic group, TAS were higher than the other groups, TOS peak was at the second hour (p

Delta-6 desaturase (D6D), encoded by the Fads2 gene, catalyzes the first step in the conversion of a-linolenic acid to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The ablation of D6D in whole body Fads2-/- knockout (KO) mice results in an inability to endogenously produce EPA and DHA. Evidence supports a beneficial role for EPA and DHA on insulin-stimulated glucose disposal in skeletal muscle in the context of a metabolic challenge; however, it is unknown how low EPA and DHA levels impact skeletal muscle fatty acid composition and insulin signaling in a healthy context. The objective of this study was to examine the impact of ablating the endogenous production of EPA and DHA on skeletal muscle fatty acid composition, whole body glucose and insulin tolerance, and a key marker of skeletal muscle insulin signaling (pAkt). Male C57BL/6J wild-type (WT), Fads2+/- heterozygous, and Fads2-/- KO mice were fed a low-fat diet (16% kcal from fat) modified to contain either 7% w/w lard or 7% w/w flaxseed for 21 wk. No differences in total phospholipid (PL), triacylglycerol, or reactive lipid content were observed between genotypes. As expected, KO mice on both diets had significantly less DHA content in skeletal muscle PL. Despite this, KO mice did not have significantly different glucose or insulin tolerance compared with WT mice on either diet. Basal pAktSer473 was not significantly different between the genotypes within each diet. Ultimately, this study shows for the first time, to our knowledge, that the reduction of DHA in skeletal muscle is not necessarily detrimental to glucose homeostasis in otherwise healthy animals. NEW & NOTEWORTHY Skeletal muscle is the primary location of insulin-stimulated glucose uptake. EPA and DHA supplementation has been observed to improve skeletal muscle insulin-stimulated glucose uptake in models of metabolic dysfunction. Fads2-/- knockout mice cannot endogenously produce long-chain n-3 polyunsaturated fatty acids. Our results show that the absence of DHA in skeletal muscle is not detrimental to whole body glucose homeostasis in healthy mice. [ABSTRACT FROM AUTHOR]

Objectives: Untreated hypoglycemia at profoundly low levels restrains the delivery of energy to vital organs and causes a series of extreme adverse events, ultimately resulting in coma and death. The purpose of the study was to determine the relationship between body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and co-morbidities in patients experiencing hypoglycemia during an oral glucose tolerance test (OGTT). Materials and Methods: We retrospectively analyzed the medical records of all patients presented to the diet outpatient clinic between 2015 and 2020 for OGTT. After an overnight fast of 10-12 hours, the patient’s fasting insulin (HOMA-IR) and fasting glucose were recorded. A 330cc solution of glucose (containing 75 grams of dextrose anhydride) drink was used for the OGTT. Following this, blood glucose was measured at 30, 60, 120, 180, and 240 minutes. The obtained data were analyzed using descriptive and inferential statistics. Results: A total of 614 patients were analyzed. A positive correlation was found between BMI and HOMA-IR (p≤0.001), BMI and blood glucose (p≤0.001). Although hypoglycemia rates were higher in overweight and obese patients, the difference was not significant (p= 0.316). The presence of co-morbidity did not affect the incidence of hypoglycemia (p=0.413). Conclusion: We observed that increased BMI was associated with having HOMA-IR and high glucose levels at 0-30-60-120 minutes in OGTT. Although hypoglycemia during the OGTT was not associated with BMI in this study, large-scale studies are needed to reveal this relationship. [ABSTRACT FROM AUTHOR]

Anredera cordifolia (Ten.) Stennis, also known as Binahong (B), is an Indonesian plant used to treat diabetes. The purpose of this study was to determine the best extragent for preparing Binahong extract as an antidiabetic agent using different concentrations of ethanol (50%, 70%, and 96%), labelled as BE50%, BE70%, and BE96%. An alpha-glucosidase inhibiting assay was used to assess the activity. The most active extract was tested in vivo assay using an oral glucose tolerance test (OGTT) and alloxan-high feed diet (alloxan-HFD)-induced diabetes in rats, with glucose level and beta cell Langerhans repair as parameters. A molecular assay was also performed to look into the expression of homeostasis regulator genes on 3T3-L1 adipose cells. The results showed that 96% ethanol extract (BE96%) inhibited alpha-glucosidase the most effectively (IC50 119.78± 11.14 μg/mL). The in vivo assay revealed that the treatment BE96% at 250 mg/kg BW for 21 consecutive days significantly reduced plasma glucose levels in Type 2 DM rats compared to the control group (p ≤ .05) with improved of Langerhans beta cells. BE96% also significantly reduced postprandial glucose levels. At the cellular level, Oil-Red-O staining revealed that differentiated adipocytes treated with BE96% had the highest lipid absorbance (p ≤ .05), compared to the control. BE96% significantly increased the expression of Glucose Transporter Isoform 4 (GLUT4) at the molecular level. It could be concluded that BE96% exhibited the best antidiabetic properties. [ABSTRACT FROM AUTHOR]

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

Abstract Background Recognizing that hyperglycemia in pregnancy can impact both individually a patient’s health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT). Methods This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants. Results Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m2, odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02–1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17–6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47–4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70–9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06–8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23–6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93–11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth. Conclusions Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism.

IntroductionWomen with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.Research design and methodsSemi-structured interviews with participants recruited via Australia’s National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify ‘important’ domains which we then mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model.ResultsNineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: ‘knowledge’, ‘memory, attention, and decision-making processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, ‘beliefs about consequences’, ‘social role and identity’, and ‘beliefs about capabilities’. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.ConclusionsThis study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM.

The negative control group (NC), and those STZ-induced hyperglycemic mice gavage supplemented with dH2O (STZ group), soybean residue (SR group), short time soybean residue fermentation (SSRF group) and longtime soybean residue fermentation (LSRF group). Surprisingly, inconsistent isoflavones content in soybean residues imply the efficacy in optimizing utilization of soy isoflavones in soy products demand more investigation. Keywords: soybean residue; Rhizopus oligosporus; Lactiplantibacillus plantarum; isoflavone; -aminobutyric acid (GABA); antioxidant; hyperglycemia; kidney; histopathology; diabetic mice; solid-state fermentation; blood glucose level monitoring; glucose tolerance test; kidney histopathological examination EN soybean residue Rhizopus oligosporus Lactiplantibacillus plantarum isoflavone -aminobutyric acid (GABA) antioxidant hyperglycemia kidney histopathology diabetic mice solid-state fermentation blood glucose level monitoring glucose tolerance test kidney histopathological examination 1716 15 11/17/22 20221101 NES 221101 1. Additionally, the STZ-induced hyperglycemic mice are gavage fed dH2O (STZ group), soybean residue (SR group), short time soybean residue fermentation (SSRF group) and longtime soybean residue fermentation (LSRF group). [Extracted from the article]

Background: Gestational diabetes mellitus (GDM) is associated with hypertension, preeclampsia, stillbirth, macrosomia, unexplained intrauterine death, instrumental and traumatic delivery leading to both maternal and foetal injuries, and increased risk of maternal and neonatal infections. The present study was conducted at Rajendra Institute of Medical Sciences, Ranchi to determine the prevalence of Gestational Diabetes Mellitus(GDM) and its associated risk factors in tribal population of Jharkhand. Aims and Objectives: The aim of the study was to determine the prevalence of GDM and to analyze its association with various risk factors. Materials and Methods: Detailed history of all patients was taken with emphasis on genetic and family history and history of the previous pregnancies. All the patients were screened by the single step 75 gm 2 hours oral glucose tolerance test (OGTT) as recommended by the World Health Organization. GDM was diagnosed if 2 hours PG is ≥140 mg/dL. Results: Most patients of GDM were from upper middle class 45.45%, followed by lower middle class (27.27%) and upper lower class (18.18%). For the non-GDM patients, most patients were from upper lower class (55.055%), followed by upper middle (24.71%). The prevalence of GDM was 12.12 % in the tribal population as compared to non-tribal population (10.44 %). In present study, in majority (89.00 %) of study subjects, result of 75 gm OGTT was negative. Result of 75 gm OGTT was positive in only 11 out of 100 study subjects (11.00 %). Conclusion: Tribal population in Jharkhand has very poor access to health-care services of the state. This study is first of its kind in our state which will set as an eye opener to further deliver better health-care facilities at grassroot level in Jharkhand. [ABSTRACT FROM AUTHOR]

This is a case study of a 26-week pregnant woman requiring an antiemetic before a glucose tolerance test and the prescribing decision that a non-medical midwifery prescriber needed to make in the outpatient setting. The case study demonstrates how the prescriber demonstrated the Royal Pharmaceutical Society competencies. The Calgary-Cambridge model was used to assess the patient. There are no local or national guidelines for this situation with very limited evidence available to assess the effectiveness of the different antiemetics. The consultant's advice in the local setting is to prescribe a cyclizine 50mg tablet. This case study evaluates the available evidence and guidelines and concludes that prescribing cyclizine in this scenario is reasonable in the absence of any good evidence. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The general population is ageing, involving an enhanced incidence of chronic diseases such as type 2 diabetes. With ageing, DNA methylation of FHL2 increases, as well as expression of the four and a half LIM domains 2 (FHL2) protein in human pancreatic islets. We hypothesised that FHL2 is actively involved in glucose metabolism. Methods: Publicly available microarray datasets from human pancreatic islets were analysed for FHL2 expression. In FHL2-deficient mice, we studied glucose clearance and insulin secretion. Gene expression analysis and glucose-stimulated insulin secretion (GSIS) were determined in isolated murine FHL2-deficient islets to evaluate insulin-secretory capacity. Moreover, knockdown and overexpression of FHL2 were accomplished in MIN6 cells to delineate the underlying mechanism of FHL2 function. Results: Transcriptomics of human pancreatic islets revealed that individuals with elevated levels of HbA1c displayed increased FHL2 expression, which correlated negatively with insulin secretion pathways. In line with this observation, FHL2-deficient mice cleared glucose more efficiently than wild-type littermates through increased plasma insulin levels. Insulin sensitivity was comparable between these genotypes. Interestingly, pancreatic islets isolated from FHL2-deficient mice secreted more insulin in GSIS assays than wild-type mouse islets even though insulin content and islet size was similar. To support this observation, we demonstrated increased expression of the transcription factor crucial in insulin secretion, MAF BZIP transcription factor A (MafA), higher expression of GLUT2 and reduced expression of the adverse factor c-Jun in FHL2-deficient islets. The underlying mechanism of FHL2 was further delineated in MIN6 cells. FHL2-knockdown led to enhanced activation of forkhead box protein O1 (FOXO1) and its downstream genes such as Mafa and Pdx1 (encoding pancreatic and duodenal homeobox 1), as well as increased glucose uptake. On the other hand, FHL2 overexpression in MIN6 cells blocked GSIS, increased the formation of reactive oxygen species and increased c-Jun activity. Conclusions/interpretation: Our data demonstrate that FHL2 deficiency improves insulin secretion from beta cells and improves glucose tolerance in mice. Given that FHL2 expression in humans increases with age and that high expression levels of FHL2 are associated with beta cell dysfunction, we propose that enhanced FHL2 expression in elderly individuals contributes to glucose intolerance and the development of type 2 diabetes. Data availability: The human islet microarray datasets used are publicly available and can be found on https://www.ncbi.nlm.nih.gov/geo/. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

Momordica charantia, a tropical plant, is used in traditional medicine to treat multiple ailments, including diabetes. Several studies have identified compounds with anti-hyperglycemic activity in crude or partially purified M. charantia extracts. However, systematic identification and purification studies validating the bioactivity of active components are unavailable to date. The present study aimed to use an extensive bioactivity guided purification strategy to identify and characterize the proteinaceous active components of M. charantia. The purification scheme, involving acid–ethanol extraction of M. charantia seeds, fractionation by isoelectric precipitation, gel filtration, and reverse-phase HPLC, yielded an anti-hyperglycemic protein fraction consisting of two heterodimeric proteins with molecular masses of 11.70 kDa and 11.47 kDa. Further analyses confirmed that both proteins had characteristics of napin-like proteins. Administration of the purified protein fraction to diabetic animals significantly decreased blood glucose. Acute toxicity studies involving repeated administration of the active peak fraction to experimental animals did not indicate any hepatotoxicity or nephrotoxicity. Furthermore, we evaluated the anti-hyperglycemic activity of a recombinant napin-like protein of M. charantia in diabetic animals, thus confirming our findings that purified napin-like proteins have anti-hyperglycemic activity.

Background We investigated how 100-g oral glucose tolerance test (OGTT) results can be used to predict adverse pregnancy outcomes in gestational diabetes mellitus (GDM) patients. Methods We analyzed 1,059 pregnant women who completed the 100-g OGTT between 24 and 28 weeks of gestation. We compared the risk of adverse pregnancy outcomes according to OGTT patterns by latent profile analysis (LPA), numbers to meet the OGTT criteria, and area under the curve (AUC) of the OGTT graph. Adverse pregnancy outcomes were defined as a composite of preterm birth, macrosomia, large for gestational age, low APGAR score at 1 minute, and pregnancy-induced hypertension. Results Overall, 257 participants were diagnosed with GDM, with a median age of 34 years. An LPA led to three different clusters of OGTT patterns; however, there were no significant associations between the clusters and adverse pregnancy outcomes after adjusting for confounders. Notwithstanding, the risk of adverse pregnancy outcome increased with an increase in number to meet the OGTT criteria (P for trend=0.011); odds ratios in a full adjustment model were 1.27 (95% confidence interval [CI], 0.72 to 2.23), 2.16 (95% CI, 1.21 to 3.85), and 2.32 (95% CI, 0.66 to 8.15) in those meeting the 2, 3, and 4 criteria, respectively. The AUCs of the OGTT curves also distinguished the patients at risk of adverse pregnancy outcomes; the larger the AUC, the higher the risk (P for trend=0.007). Conclusion The total number of abnormal values and calculated AUCs for the 100-g OGTT may facilitate tailored management of patients with GDM by predicting adverse pregnancy outcomes.

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic.MethodsRetrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018–12/31/2018 and 03/10/2019–12/31/2019) and early COVID-19 pandemic (03/10/2020–12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds.ResultsThe three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p

Background: Coronary artery disease (CAD) is one of the most common morbidities associated with diabetes mellitus. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are precursors to diabetes and major risk factors for atherosclerosis. The study aimed to evaluate the prevalence of IFG and IGT in nondiabetic patients with CAD. Methods: The study was performed on 100 non-diabetic patients with CAD and 50 healthy age- and sex-matched controls. Data were collected via detailed medical history taking, clinical examination, routine blood chemistry tests, fasting blood sugar test, 2-hour post-prandial blood sugar test, lipid profile, electrocardiogram, 2D-echocardiogram, and carotid Doppler. Results: Dyslipidemia was more prevalent among the patients. The mean carotid intima–media thickness was higher in the patients. Overall, IFG was found in 9 (15%) cases and IGT was found in 13 (22%) cases. The co-existence of IFG and IGT was detected in 3 (5%) cases. Abnormal glucose regulation was found in 42% of patients. Conclusion: The findings indicate the need for early screening and management of prediabetes for the prevention of further progression to diabetes.

Background: It is unclear whether replacing oral glucose tolerance test (OGTT) with hemoglobin A1c (HbA1c) measurement for diagnosing diabetes is justified. We aimed to assess the proportion of OGTT-diagnosed diabetes cases that can be confirmed by HbA1c and to examine whether individuals with OGTT diagnosis but nondiagnostic HbA1c are at higher risk of macrovascular and microvascular disease.Methods: Participants were 5773 men and women from the population-based Whitehall II prospective cohort study in the United Kingdom. New OGTT diabetes cases diagnosed in clinical examinations in 2002 to 2004 and 2007 to 2009 were assessed for HbA1c confirmation (≥6.5%) in these and subsequent clinical examinations in 2012 to 2013 and 2015 to 2016. All participants were followed up for major cardiovascular events through linkage to electronic health records until 2017 and for incident chronic kidney disease (estimated glomerular filtration rate <60 mL·min-1·1.73 m-2) until the last clinical examination. In analysis of vascular disease risk, new OGTT-diagnosed diabetes cases with and without diagnostic HbA1c and preexisting diabetes cases were compared with diabetes-free participants.Results: Of the 378 (59.3%) participants with OGTT-diagnosed diabetes, 224 were confirmed by HbA1c during 4.1 years (SD, 4.1 years) of follow-up. We recorded 942 cardiovascular events over 12.1 years. After adjustment for nonmodifiable risk factors and compared with the 4997 diabetes-free participants, 371 participants with new HbA1c-confirmed diabetes and 405 participants with preexisting diabetes had increased risk of cardiovascular disease (hazard ratio, 1.53 [95% CI, 1.12-2.10] and 1.85 [95% CI, 1.50-2.28], respectively). The corresponding hazard ratios in the analysis of incident chronic kidney disease (487 cases; follow-up, 6.6 years) were 1.69 (95% CI, 1.09-2.62) for 282 participants with new HbA1c-confirmed diabetes and 1.67 (95% CI, 1.22-2.28) for 276 participants with preexisting diabetes. In both analyses, OGTT cases with nondiagnostic HbA1c (n=149 and 107) had a risk (hazard ratio, 0.99-1.07) similar to that of the diabetes-free population.Conclusions: More than 40% of OGTT-diagnosed diabetes cases were not confirmed by HbA1c during an extended follow-up. However, because these individuals have a risk of cardiovascular disease and chronic kidney disease similar to that of the diabetes-free population, replacement of OGTT with HbA1c-based diagnosis appears justified. [ABSTRACT FROM AUTHOR]

Background: Pregnancy, parturition, and the onset of lactation represent an enormous physiological and hormonal challenge to the homeostasis of dairy animals, being a risk for their health and reproduction. Thus, as a part of the homothetic changes in preparturition period, goats undergo a period of IR as well as uncoupled GH/IGF-1 axis. The objective for this study was to determine the effect of berberine (BBR) during the peripartal period on hormonal alteration and somatotropic axis in dairy goats as well as glucose and insulin kinetics during an intravenous glucose tolerance test (IVGTT). At 21 days before the expected kidding date, 24 primiparous Saanen goats were assigned randomly to 4 dietary treatments. Goats were fed a basal diet from wk. 3 antepartum (AP) until wk. 3 postpartum (PP) supplemented with 0 (CTRL), 1 (BBR1), 2 (BBR2), and 4 (BBR4) g/d BBR. Blood samples were collected on days − 21, − 14, − 7, 0, 7, 14, and 21 relative to the expected kidding date. An IVGTT was also performed on day 22 PP. Results: Compared with CTRL, supplementation with either BBR2 or BBR4 increased DMI at kidding day and PP, as well as body conditional score (BCS) and milk production (p ≤ 0.05). On d 7 and 14 PP plasma glucose was higher in BBR2- and BBR4-treated than in CTRL. The glucagon concentration was not affected by BBR during the experimental period. However, supplemental BBR indicated a tendency to decrease in cortisol concentration on days 7 (p = 0.093) and 14 (p = 0.100) PP. Lower plasma GH was observed in BBR than in non-BBR goats (p ≤ 0.05). Plasma IGF-1 concentration was enhanced in both BBR2 and BBR4 at kidding and day 7 PP (p ≤ 0.05). During the IVGTT, glucose area under the curve (AUC), clearance rate (CR), T1/2, and Tbasal was lower (p ≤ 0.05) in both BBR2 and BBR4 goats as compared with CTRL. Likewise, the insulin CR was higher (p ≤ 0.05) in goats receiving either BBR2 or BBR4 which was accompanied by a lower insulin T1/2 and AUC. Conclusions: Altogether, our results indicated an improved glucose and insulin status along with the modulation of the somatotropic axis and glucose and insulin response to IVGTT in dairy goats supplemented with 2 and 4 g/d BBR. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context The relationships of gastric emptying (GE) with the glycemic response at 120 minutes, glucagon-like peptide-1 (GLP-1), and insulin secretion following a glucose load in type 2 diabetes (T2D) are uncertain. Objective: We evaluated the relationship of plasma glucose, GLP-1, and insulin secretion with GE of a 75-g oral glucose load in T2D. Design: Single-center, cross-sectional, post hoc analysis. Setting: Institutional research center. Participants: 43 individuals with T2D age 65.6 ± 1.1 years, hemoglobin A1c 7.2 ± 1.0%, median duration of diabetes 5 years managed by diet and/or metformin. Intervention: Participants consumed the glucose drink radiolabeled with 99mTc-phytate colloid following an overnight fast. GE (scintigraphy), plasma glucose, GLP-1, insulin, and C-peptide were measured between 0 and 180 minutes. Main Outcome Measures: The relationships of the plasma glucose at 120 minutes, plasma GLP-1, and insulin secretion (calculated by Δinsulin0-30/Δglucose0-30 and ΔC-peptide0-30/Δglucose0-30) with the rate of GE (scintigraphy) were evaluated. Results: There were positive relationships of plasma glucose at 30 minutes (r = 0.56, P < 0.001), 60 minutes (r = 0.57, P < 0.001), and 120 minutes (r = 0.51, P < 0.001) but not at 180 minutes (r = 0.13, P = 0.38), with GE. The 120-minute plasma glucose and GE correlated weakly in multiple regression models adjusting for age, GLP-1, and insulin secretion (P = 0.04 and P = 0.06, respectively). There was no relationship of plasma GLP-1 with GE. Multiple linear regression analysis indicated that there was no significant effect of GE on insulin secretion. Conclusion: In T2D, while insulin secretion is the dominant determinant of the 120-minute plasma glucose, GE also correlates. Given the relevance to interpreting the results of an oral glucose tolerance test, this relationship should be evaluated further. There appears to be no direct effect of GE on either GLP-1 or insulin secretion. [ABSTRACT FROM AUTHOR]